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Research & Reviews: A Journal of Unani, Siddha and Homeopathy Role of

Hijama (Cupping) in the Management of Various Diseases and Probable
Mechanism of Action

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 Research & Reviews: A Journal of Unani, Siddha and Homeopathy
ISSN: 2394-1960 (Online)
Volume 5, Issue 2
www.stmjournals.com

Role of Hijama (Cupping) in the Management of Various

Diseases and Probable Mechanism of Action
Muzafar Din Ahmad Bhat1,*, Abrar Mohd. Khan2, Arisha Shahid1
1
Department of Moalajat, National Institute of Unani Medicine, Bengaluru, Karnataka, India
2
Department of Moalajat, Rajasthan Unani Medical College and Hospital, Jaipur, Rajasthan, India

Abstract
Hijama is derived from Arabic word ‘Hajm’ which literally means to suck. It involves the use
of cup like vessels placed on the body surface by creating a vacuum to either let out blood
from below the skin surface or just plain suction without bloodletting. Hijama evacuates blood
from small vessels spread over the skin and muscles and relieves congestion from the body. It
is a therapy with low cost and almost no side effects. The duration and amount of cups used
depend upon the severity of disease and also on the personal experience of the practitioner. In
ancient Unani literature, physicians have mentioned Hijama to be useful in curing a vast
number of diseases, may it be of any temperament or humour. Mechanism of action of Hijama
is still unknown as there are several methods of Hijama and each method has its own mode of
action which could illustrate the effect of Hijama therapy. Studies on Hijama techniques are
significantly limited and lack comprehensiveness. Furthermore, Hijama is yet to be fully
standardized, which makes the result of various studies on the techniques of Hijama
practically incomparable due to difference in terms of treatment methods and protocols. This
article deals with a detailed description of all the aspects of Hijama therapy and explores the
mechanics involved with Hijama.

Keywords: Hijama therapy, Unani System of medicine, Hijama bi’l shart, Hijama bi’la shart

*Author for Correspondence E-mail: drmuzaffar79@gmail.com

INTRODUCTION Hijama is being done is called ‘Mahjoom’

Hijama is an Arabic word referring to one of
the procedures of ilaj bi’l tadbeer described in
Unani system of medicine which includes
evacuation of morbid matter from the body
using cup shaped vessels. In Urdu language,
the word ‘Hijama’ refers to a barber. In earlier
times, the barbers used to perform Hijama as
well cut hair, this may be the reason why the
word Hijama became synonymous with
cutting hair.
[1, 2].
Historical Background
Hijama dates back as long as 3000BC. The
oldest record about use of Hijama is preserved
in the Ebers Papyrus, one of the most seasoned
restorative reading materials on the planet. It
portrays the methodical utilization of Hijama
by the early Egyptians, as far back as 1,550BC
[3-5].

The vessel used for hijama is called a
‘Mihajima’. During ancient times, hollow
animal horns were used as Mihajima, but later
on people started making them from mud,
glass and other materials, and today, plastic
disposable cups are also available in the
market to be used as Mihajima. Other
terminologies associated with Hijama are: the
person performing Hijama is called a
‘Hajjam’, the person undergoing Hijama is
called ‘Muhajjim’ and the body part on which
Hippocrates (460-377BC) wrote a book on
Hijama and Fasd, later on translated by
Yuhanna Bin Maswaih in to Arabic under the
title “Kitab fil Fasd wal Hijama” [6].
Unani classical books reveal that it was
amongst the most prevalent strategies for
treatment among all groups. So much so that
Raban Tabri (780-850AD) devoted a complete
book to Hijama named “Al-Kitab fil Hijama”
[7].

RRJoUSH (2018) 19-23 © STM Journals 2018. All Rights Reserved Page 19
Role of Hijama (Cupping) in Management of Diseases
Zakariya Razi (850-923AD) described Hijama
to be the cure of a number of ailments in his
book “Kitab al Mansoori” and “Al Hawi” [8,
9]. He mentioned under the management of
Irq-al-Nasā (Sciatica) in Al Hawi fit Tib, that
if the thick and firm morbid material gets
collected in hip, Hijama tends to be an
essential and impressive treatment [9].
Ali Ibn Abbas Majoosi (930-994AD) has
additionally depicted the types, sites, signs,
safety measures of Hijama, and the most
precise time to perform Hijama in second
volume of “Kamilus Sana’a” [10].
Abu al Qasim Zahrawi (936-1036 AD) has also
described Hijama in his book “Kitab al
Tasreef” along with a detailed description of the
sites of Hijama [11].
Sina (980-1037 AD) in his treatise “Al-Qanoon
fil Tib” [12] and Ismail Jurjani in his book
“Zakhira Khwarzim Shahi” have analysed
Hijama in a thorough manner.
Ibn ul Quf (1233-1286AD) in his book “Kitab
al Umdah fil Jarahat” described Hijama into
two different types, i.e., Hijama bilā Shart and
Hijama bi'l Shart thus, illustrating the
principles of Hijama [13].
Ibn Hubal Baghdadi (13th century AD) has
furthermore delineated the types and sites of
Hijama, in his book “Kitab al Mukhtarat fit Tib.
In perspective of popularity and effectiveness
of Hijama in the treatment of different kinds of
musculoskeletal disorders as well as other
illnesses, a few government and non-
governments associations of India have begun
clinical examinations and work to demonstrate
the viability of Hijama. Unani medical colleges
should be specifically mentioned in this
context. Under this development, a separate
setup for Hijama has been established in
National Institute of Unani Medicine
Bangalore, where Hijama is in routine practice
since 2004.
HIJAMA
Definition
It is a form of local evacuation of humours
which gets accumulated due to Imāla and
RRJoUSH (2018) 19-23 © STM Journals 2018. All Rights Reserved
Bhat et al.
attraction of humours from the diseased site to
other site. Since these functions are carried out
using a vessel resembling a cup, its possible
English equivalent term is cupping [14].
Types of Hijama
There are two types of Hijama:
Hijama bilā Shart [1, 2, 8, 10, 13-15]
In this method, cups are used without
scarification of the site of cupping. The
stationary cups are placed on skin without
scarification and vacuum is created by various
methods as following:
i. Hijama bi’l Nār: In this type, vacuum is
created by igniting fire. Its possible
English equivalent is fire cupping or
cupping with fire [1, 10, 13, 14].
ii. Hijama bilā Nār: In this type, vacuum is
created by sucking either by mouth or by
suction pump. Its possible English
equivalent is dry cupping or cupping
without fire [1, 10, 13, 14].
iii. Hijama Mā’ī: A type of cupping in which
the decoctions of certain drugs are used [14].
Hijama bi’l Shart [1, 2, 8, 10, 12-14].
In this method, cups are used after
scarification of the site of cupping. Thus blood
oozes out due to negative pressure or vacuum
in the cups, resulting in evacuation of morbid
material from underneath the skin area. It is of
two types:
i. Zarori (essential): This is performed to
treat the ailments [13].
ii. Ikhtiyāri (voluntary): This is performed as
a preventive measure.
There are ten criteria for Hijama Ikhtiyāri
(Voluntary Cupping) [13]:
1. Hijama should be performed during the
middle days of the lunar month because
the humours are efferent and vehement
during these days [2, 12, 13].
2. Hijama should be done in the afternoon
session as this is the most balanced among
various times of the day [12, 13].
3. It should be done in summer season
because the elimination and evacuation of
matter is easy. In summer, the matter
becomes thin or less viscous due to higher
temperature and this matter has
predilection towards the external surface
of the body [2, 10, 13].
Page 20
Research & Reviews: A Journal of Unani, Siddha and Homeopathy
Volume 5, Issue 2
ISSN: 2394-1960 (Online)
4. Hijama should be done only in those
persons who are having thin or less
viscous blood [2, 13].
5. Elixirs, syrups having the property of
evacuation of matter from the body should
be given to the person before undergoing
Hijama [13].
6. Hijama should not be done on a person
whose body has become fluffy or loose
due to dissolution (Tehlil) [2, 13].
7. The age of the person undergoing Hijama
should be between 2 and 60 years. Hijama
is contraindicated below 2 years and above
60 years [2, 12, 13].
8. Hijama should not be done after Hammām
except in those people having thick or
viscous blood. This is because after
Hammām the skin becomes thicker
(dabeez), and in that case, deeper incisions
are needed to be given to evacuate the
blood which results in more pain and
weakness [2, 12, 13].
9. Hijama should not be performed after
sexual intercourse [2, 13].
10. Hijama should not be done after a
strenuous work or exercise, because
strenuous work resolves the matter
excessively and weakness may occur. But
in person having viscous blood, Hijama
can be done after strenuous work or
exercise [13].
MATERIALS AND METHODS
Instruments Needed for Hijama
Glass/acrylic cups, vacuum pump, medical
antiseptic solution, sterilized gloves, sterilized
surgical blades, sterilized surgical scalpel,
cotton, sterilized medical gauze, surgical
micropore and a razor to remove the hair of
the site if needed.
Procedure of Placing the Mihjima
Initially the Mihjima (cup) is put at the skin
and then vacuum is created moderately. It is
kept for a brief period of time and then
withdrawn so that the humours come to that
place or site. This process is repeated till that
site becomes red, swollen and redness of blood
appears over there. Now incision is given over
the site of cupping. Incision should be wide,
horizontal and a bit deep, preferably along the
whole thickness of the skin. It is done so that
the blood may get eliminated from deeper
tissues. First time the cup is adhered for a
RRJoUSH (2018) 19-23 © STM Journals 2018. All Rights Reserved
short duration and then the time of adherence
is slowly increased [2, 12].
Mechanism of Action of Hijama bi’l Shart
(as per Concepts of Unani System of
Medicine)
Physician is a servant of Tabīʻat and its
functions. Body fluid or morbid matter does
not evacuate itself unless Tabīʻat-e-badnīʻā or
Tabīʻat-e-khiltīʻā acts on it, the former one is
called Harakat-e-qasrīʻā and the latter one is
known as Harakat-e-tābīʻā. When Tabīʻāt
wants to evacuate the morbid matter, it needs
some help for doing this. This is achieved by
opening the vessels on skin by scarification
and vacuum is created so that the blood along
with morbid matter will be evacuated easily,
this process is called Hijama bi’l Shart [13].
Hijama evacuates the matter from the small
blood vessels spread in skin, and flesh that is
why it does not produce weakness as happens
with venesection. It reduces the congestion of
the organ where cupping is done and also
reduces the congestion of adjacent organs.
Mechanism of Action of Hijama bi’l Shart
(as per Concepts of Modern Science)
Exact mechanism of Hijama bi’l Shart is still
unknown but many researchers try to explain
the mechanism of action of Hijama bi’l Shart
through some theories like Pain gate theory,
Prostaglandins theory, Endorphins and
Encephalin Production theory, Nitric oxide
theory and Taibah theory etc. [3, 16]. The
short description of each of these theories is
given as under:
Pain Gate Theory
This theory states that there is a gate or
channel through which pain signal from actual
site of pain is transferred to the brain [17, 18].
When the Mihjama (suction cup) is placed
over this channel, it produces pain which
interferes with the actual pain which cannot be
transmitted in the same gate or channel and in
this way, elimination of pain occur [3].
Prostaglandin Theory
Prostaglandins are produced as a result of
inflammation in our body and these
prostaglandins transmit pain signals to the
brain [19]. By performing Hijama bi’l Shart,
these products are removed from the body and
this results in reduction of pain [16].
Page 21
Role of Hijama (Cupping) in Management of Diseases Bhat et al.

Endorphins and Encephalin Production Table 1: Sites of Hijama.

Theory S.
Site of Hijama bi’l Shart Benefits
These are natural endogenous opioid No.
Al Hāmmah (Vertex) Fair skin, Ophthalmic
components released (Endorphins from 1.
[2, 13] diseases
Pituitary gland and Encephalin from Brain) in Nuqrā (Nape of neck) Ophthalmic, Nervous
our body and are called as ‘endogenous 2.
[1, 2, 8, 12, 13] and Skin Diseases
pleasure substances’ which result in pain 3.
Qamahduwā (Occipital) Psychological disorder,
reduction and mode enhancement [20, 21]. [2, 10, 13] Vertigo
Akhdā (Side of neck) Gingivitis, Glossitis,
4.
[2, 8, 10, 12, 13] Conjunctivitis
Nitric Oxide Theory Tahat-ul-dīqan (Below Tonsillitis, diseases of
Nitric oxide is very important substance 5.
chin) [2, 8, 10, 13] gum and cheeks
released in the body as a result of any trauma Tashrīt (Ear lobules)
6. Headache
[22, 23]; and it is also released during or after [10, 13]
Kaahīl (Inter scapular Throat pain, Asthma,
Hijama bi’l Shart. The functions of nitric oxide 7.
region) [2, 8, 10, 12, 13] Diphtheria
are: Spleenomegaly,
• Vasodilatation: this allows more blood flow 8. Munkab [12, 13]
Hepatitis
to the area [3, 16]. 9. Rusgh (wrist bone) [10]
Scabies, itching and
• Two way vasodilatation effects [3, 16]. ulceration of hands
10. Naghīs [13] Liver and spleenic pain
• Muscle relaxation which cures spasms [3, Sciatica, Gout,
16]. 11. Qatan (Loin) [2]
Filariasis, Haemorrhoids
• Anti-thrombotic: protects the vessels from 12.
Maqʻad (Anal region)
Piles, Amenorrhoea
thrombosis [3, 16]. [10, 13]
Fakīd (Anterior aspect of Orchitis and lower limb
• Anti-inflammatory and prevents narrowing 13.
thigh) [12, 13] abscess
of blood vessels lumen [3, 16]. Fakīd (Posterior aspect of Coxalgia, Haemorrhoids
14.
thigh) [12, 13] and Aanal fissure
Taibah Theory 15.
Al Rakba (Knee)
knee Pain
This theory is currently the most accurate [2, 10, 12, 13]
Chronic diseases of
scientific explanation of Hijama therapeutic Sādqain (Calf Muscles) Kidney, Urinary
properties. Taibah theory explains that Hijama 16.
[8, 10] Bladder and Uterus, as
bi’l Shart is a minor surgical excretory an Emmenagogue
procedure and it acts in the same way as does
the mechanism of excretory function via needs some help for doing this. This is achieved
glomerular filtration of the kidney as well as by opening the vessels on skin by scarification
drainage of abscess, removing the pathological and vacuum is created so that the blood along
substances from the body [3, 16, 24]. with morbid matter will be evacuated easily,
this process is called Hijama bi’l Shart. Hijama
Sites of Hijama bi’l Shart is yet to be fully standardized and still needs
According to Abu al Qasim Zahrawi, there are scientific interpretation.
fourteen spots on the body where Hijama bi’l
Shart is done [11]. Some important sites where SOURCE OF SUPPORT
Hijama bi’l Shart is done are shown in Table 1. Nil.

CONCLUSION CONFLICT OF INTEREST

Hijama is one of the procedures of Ilaj bi’l
tadbeer (Regimenal therapy) described in
Unani system of medicine which includes
evacuation of morbid matter from the body
using cup shaped vessels. Both modern
medicine and prophetic medicine proved the
beneficial value of Hijama in treatment of
diseases that are different in etiology and
pathogeneses. When Tabīʻāt (medicatrix
naturae) wants to evacuate the morbid matter, it
The authors declare that there is no conflict of
interest.
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Cite this Article
Muzafar Din Ahmad Bhat, Abrar Mohd.
Khan, Arisha Shahid. Role of Hijama
(Cupping) in the Management of Various
Diseases and Probable Mechanism of
Action. Research & Reviews: A Journal of
Unani, Siddha and Homeopathy. 2018;
5(2): 19–23p.
Page 23